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Views And Reviews

NHS antidepressant prescribing: what do we get for £266m a year?

BMJ 2018; 360 doi: (Published 06 March 2018) Cite this as: BMJ 2018;360:k1019
  1. Derek Summerfield, honorary clinical senior lecturer
  1. Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
  1. derek.summerfield{at}

This “epidemic” of depression lets the neoliberal political and economic order off the hook

The Royal College of Psychiatrists and the media routinely state that there is an “epidemic” of mental disorder—one in four people in the UK, with three in four said not to get the treatment they need. These disease mongering assertions have been recycled for so long that they have become unexamined societal truisms.

We are apparently wading knee deep in “mental disorder,” yet psychiatry has not confronted the philosophical problem of defining just what we mean by “mental disorder.” Barring categories arising directly from physical disease (for example, dementia), there is no conceptual agreement about when a person “really” has a mental disorder, only the constructed agreement inherent in the methodologies that psychiatry has adopted.1 If there are sufficient phenomena, at sufficient threshold, a mental disorder is declared to exist. This is a kind of alchemy. If to …

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